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M

i f l U

f H lth

Meaningful Use of Health 

Information Technology Requires a 

Competent Workforce

William Hersh, MD Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University

Oregon Health & Science University Portland, OR, USA

(2)

Overview of talk

Overview of talk

Why we need more health information

Why we need more health information 

technology (HIT)

What we know about the HIT workforce

What we know about the HIT workforce

(3)

The biggest advocate for HIT

The biggest advocate for HIT

“To improve the quality of our

To improve the quality of our 

(4)

Health Information Technology for 

i

d li i l

l h (

)

Economic and Clinical Health (HITECH) Act

Portion of the American Recovery and 

y

Reinvestment Act (ARRA) that allocates $40 

billion to the Office of the National Coordinator 

for Health IT (ONC) to provide incentives for

for Health IT (ONC) to provide incentives for 

“meaningful use” of HIT through

Adoption of electronic health records (EHRs)

Health information exchange (HIE)

Infrastructure

Regional extension centers – 60 across country

Regional extension centers  60 across country

Research centers – four centers in specific areas

(5)

Why do we need more information 

h

l

( ) i h l h

?

technology (IT) in healthcare?

Quality – not as good as it could be

Quality  not as good as it could be 

(McGlynn 2003;(McGlynn, 2003;  NCQA, 2009; Schoen, 2009)

Safety – IOM “errors report” found up to 

y

p

p

98,000 deaths per year 

(Kohn, 2000)

Cost – rising costs not sustainable; US spends

Cost  rising costs not sustainable; US spends 

more but gets less 

(Angrisano, 2007)

Inaccessible information missing information

Inaccessible information – missing information 

(6)

What do we know about the HIT 

kf

workforce?

Largest (but not only) need now in healthcare settings

Traditional groupings of professionals in healthcare

Information technology (IT) – usually with computer 

science or information systems background

science or information systems background

Health information management (HIM) – historical focus 

on medical records; certified as

Registered Health Information Administrator (RHIA)

Registered Health Information Administrator (RHIA)

Registered Health Information Technologist (RHIT)

Clinical Coding Specialist (CCS)

Clinical informatics (CI) – often from healthcare

Clinical informatics (CI)  often from healthcare 

backgrounds; focus on use of clinical information

(7)

What do the data show?

What do the data show?

Mostly done in hospital settings; usually

Mostly done in hospital settings; usually 

focused on one (of three main) groups

IT – HIMSS Analytics Database™ study

IT – HIMSS Analytics Database  study

(8)

HIMSS Analytics study

y

y

(Hersh and Wright, 2008)

(9)
(10)

Results

Results

IT per non‐IT staff ~ 1:60

0.25

p

IT FTE per bed rises from 

stages 0 to 4

Extrapolating to country

0.1 0.15 0.2 FT E per B e d

Extrapolating to country 

as a whole

108,390 IT staff at current 

d

i

l

l

0 0.05 0 1 2 3 4 5 6 7 IT

adoption levels

Would increase to 149,174 

if all stages <4 hospitals 

d t

t

4

EMR Adoption Model™ Score

(11)

HIM data from US Bureau of Labor 

Statistics

From US Bureau of Labor Statistics

From US Bureau of Labor Statistics 

occupational employment projections 2008‐

2018 (BLS 2009)

2018 (BLS, 2009)

Medical Records and Health Information 

Technicians (RHITs and coders) – about 172,500

Technicians (RHITs and coders)  about 172,500 

employed now, increasing to 207,600 by 2018 

(20% growth)

(12)

Clinical informatics

Clinical informatics

Individuals who bring skills at intersection of health 

care and IT 

(Hersh, 2008; Hersh, 2009)

Focus more on information than technology

Likely to lead “meaningful use” of HIT

Likely to lead  meaningful use  of HIT

Estimates of need

One physician and nurse in each US hospital (~10,000) 

(Safran 2005)

(Safran, 2005)

About 13,000 in health care 

(Friedman, 2008) 

and 1,000 in public 

health 

(Friedman, 2007)

Growing role of CMIO and other CI leaders

Growing role of CMIO and other CI leaders 

(Leviss 2006 Shaffer(Leviss, 2006, Shaffer,  2009)

(13)

ONC estimates 51,000 needed for 

d

b

l

HITECH agenda in 12 job roles

Mobile Adoption Support Roles

l l * – Implementation support specialist* – Practice workflow and information management redesign specialist* – Clinician consultant* – Implementation manager*p g

Permanent Staff of Health Care Delivery and Public Health Sites

– Technical/software support staff* – Trainer* Cli i i / bli h l h l d † – Clinician/public health leader† – Health information management and exchange specialist† – Health information privacy and security specialist†

Health Care and Public Health Informaticians

Health Care and Public Health Informaticians

(14)

How do we build the workforce?

How do we build the workforce?

Historically most education at graduate level

Informatics is inherently multidisciplinary and there is no 

single job description or career pathway

More information on programs on AMIA web site

More information on programs on AMIA web site

http://www.amia.org/informatics‐academic‐training‐

programs

Commentary at

Commentary at

http://informaticsprofessor.blogspot.com

Let’s look at

Competencies

Career pathways

(15)
(16)

Career pathways have diverse inputs 

d

and outputs

(Hersh, 2009)

There is no single

Health care professions, e.g.,  medicine, nursing, etc.

There is no single

career pathway!

Natural and life sciences, e.g.,  biology, genetics, etc.

Computer science (CS) IT and

Jobs in: • Health care systems • Clinical leadership IT l d hi Biomedical  and health  informatics  Computer science (CS), IT, and  undergrad informatics Health information  • IT leadership • Biomedical research • Industry • Academia education (usually  graduate  level) management (HIM) Others, e.g., business, library  and info science

level)

(17)
(18)
(19)

ONC workforce development program

ONC workforce development program

Community College Consortia to Educate

Community College Consortia to Educate 

(20)
(21)

Community College Consortium –

Region A

Lead – Bellevue College, Seattle, WA

g ,

,

Partners

Portland Community College (Portland, OR)

With sub‐partners – Mt. Hood, Lane, Umpqua, and Blue 

Mountain

North Idaho College (Coeur d’Alene, ID)

Salt Lake Community College (Salt Lake City, UT)

Montana Tech (Butte, MT)

Pueblo Community College (Pueblo CO)

Pueblo Community College (Pueblo, CO)

Dakota State University (Madison, SD)

(22)

Community College Consortium –

Region B

Lead – Los Rios 

Partners (cont.)

Community College 

District

(

)

Honolulu Community 

College

Mi i

C ll

Partners

Cosumnes River College

Butte College

Mission College

Orange Coast College

Phoenix College

Butte College

College of Southern 

Nevada

g

Pima College

Santa Barbara City 

College

Cypress College

East Los Angeles College

Fresno City College

College

San Diego Mesa College

Santa Monica College

(23)
(24)

Program of Assistance for 

University‐Based Training

Funding for education of individuals in job roles requiring university‐level 

training at nine universities with existing programs

training at nine universities with existing programs

– Oregon Health & Science University (OHSU) – Columbia University – University of Colorado Denver College of Nursingy g g – Duke University – George Washington University – Indiana University

(25)

Conclusions

Conclusions

Informatics is maturing as a discipline and 

g

p

profession

(26)

For more information

For more information

Bill Hersh

http://www.billhersh.info

Informatics Professor blog

http://informaticsprofessor.blogspot.com

f

l f

l

l

l

OHSU Department of Medical Informatics & Clinical Epidemiology

http://www.ohsu.edu/dmice

http://www.ohsuscholarships.info

htt //

i f

ti

http://oninformatics.com

What is BMHI?

http://www.billhersh.info/whatis

Office of the National Coordinator for Health IT

Office of the National Coordinator for Health IT

http://healthit.hhs.gov

American Medical Informatics Association

References

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